All posts for the month July, 2013

Tuesday, July 30

A statement by HHS Secretary Kathleen Sebelius

Today, we mark the 48th anniversary of Medicare and Medicaid becoming law, a sacred promise our country made to older Americans and low-income working Americans and families that they will have the medical care they need to live healthier lives.

The historic pledge acknowledges that after contributing a lifetime of hard work to our nation’s well-being, our seniors will be able to live their golden years with the security and peace of mind that comes with having affordable health coverage under Medicare.

For low-income children, parents, and people with disabilities, Medicaid created a federal-state partnership to provide a health care safety net to promote stronger families and communities across our country.

Medicaid provides health coverage to 57 million people, including more than 4.6 million low income seniors, nearly all of whom are also enrolled in Medicare, and 27.8 million children. The Affordable Care Act authorizes states to extend Medicaid coverage to adult Americans under age 65 with income up to 133 percent of the federal poverty level—and provides unprecedented federal funding for that expansion.

Medicaid expansion is a critical piece of the puzzle to ensure more Americans get the care they need. But it would also reduce the burden of uncompensated care. The Affordable Care Act allows all states to expand Medicaid coverage to reach even more people, and to make sure that your zip code doesn’t determine your health care.

And because of the Affordable Care Act, more than 16.5 million people with traditional Medicare were able to take advantage of at least one free preventive service, such as a mammogram or cardiovascular disease screening so far this year.

Since the enactment of the health care law three years ago, more than 6.6 million people with Medicare have saved more than $7 billion on prescription drugs when they fell into the “donut hole” gap in coverage. The law will close the donut hole completely by 2020.

With new tools and stronger penalties, the health care law is also protecting the health of our seniors and taxpayer dollars by helping us root out Medicare fraud, waste and abuse, resulting in record high recovery of funds: nearly $15 billion in the last four years.

The Affordable Care Act is also strengthening the Medicare Trust Fund, extending its solvency until at least 2026, nearly a decade longer than projected at the time of the law’s passage in 2010.

I call on all of you to join me in renewing the promise our nation made 48 years ago to our parents, aunts, uncles, and neighbors – and to our children – that Medicare and Medicaid will be there to help them live healthier lives, with security and peace of mind.

If you could give a community only three “dos” and three “don’ts” to make it more livable and attractive, what would they be?

Ned Crankshaw: DO center all hubs of activity as close to the center as possible. This includes schools, parks, other community facilities, and, of course, commercial enterprises. Use public buildings to support private enterprise by concentrating more people (customers). Find ways to use public facilities to provide parking or space for farmers’ markets or other events. Or rent space in historic buildings from private landlords, instead of building new buildings.

DO develop a pedestrian walkability plan for the community. Use every project – whether it is a street improvement, property development, or a new public facility – to implement the plan and improve the quality of pedestrian spaces in streets.

DO plan for the community’s central neighborhoods. Determine their challenges and opportunities. Develop financial or other incentives to encourage property owners’ investments, and put in place appropriate restrictions (through zoning overlays or other mechanisms) to discourage property neglect or inappropriate property development. The goal for many towns should be mixed-income, mixed density, livable neighborhoods that support the downtown.

DON’T design for visitors. Design for your own residents, and visitors will be taken care of in the process.

DON’Ttear down buildings unless there is a specific funded plan to replace them with better building(s).

DON’T allow single-minded concerns to harm your community. These might include the good intentions of historic preservationists, traffic engineers, and state governments that create one-size-fits-all criteria for the design of judicial centers, school buildings, or other facilities. And don’t be bullied by businesses and developers who insist that the only way they can build in your community is if the community lowers its standards. They need you.

What are the best ways to add parking in a historic downtown? How can it be both hidden and convenient?

Crankshaw: Is there really a need for additional parking? If so, determine the destinations of those who park and locate new parking where it is convenient. “Convenient” places offer a pleasant walking path, a clear view of the destination, and a reasonable-length walk (keeping in mind that the distance people are willing to walk varies from one region to another).

Parking shouldn’t be created by demolishing existing buildings, as a general rule. Investigate vacant spaces that may be suitable. Many of the best spaces may be behind buildings or in the interior of blocks and will likely cross multiple property lines. Design parking areas to make them pleasant and inviting from the interior and exterior. They are not only a utilitarian necessity, but are an important part of the experience of a downtown.

What kinds of things can professional designers miss in sizing up a town or neighborhood?

Crankshaw: Professional designers really need to spend time on the ground and in the streets experiencing towns and their neighborhoods from the perspective of those who live in them. Without that, there is a tendency to value architectural quality over the experience of daily life. Much of that daily life involves movement on sidewalks and streets, on foot and in vehicles. Street space is critical, and it depends on the collective patterns of buildings and other parts of the town landscape.

Another element that may be missed is the transitions or connections between districts of a town. Each neighborhood’s internal character is important, but to make a truly livable town they need to connect well with each other through supportive street environments.

What makes a place walkable, besides not having to cross four lanes of busy traffic?

Crankshaw: A walkable place provides supportive environments for pedestrians. That is much more than just a safe environment for pedestrians, which is an incredibly minimal threshold. Supportive pedestrian environments provide adequate path widths, buffers from vehicular traffic, visual variety and enjoyment, and shade. They should form a network that takes you places you want to go as directly as possible and with as much choice as possible.

Is it possible to overdo historic preservation?

Crankshaw: Preservation is ideological and mission-oriented. When there are competing values, it’s not always right. But because it is ideological, it always thinks it is right.

In many parts of the United States, the presence (or potential loss) of a town center with thriving businesses is an overriding concern. This is true in smaller cities and towns and in the older suburban communities of large cities. Preservationists need to support that goal even if it means backing off from their traditional fixation on details. Outside of the preservation community, who really cares if someone restores their windows by keeping the original wood, or replaces them with a reasonable substitute? What we ought to care about is that the building owner contributes to the business and social vitality of a town center.

How closely should downtown signs be coordinated?

Crankshaw: Not at all. Towns should place some limits on size, appropriate to their locality, but business and building owners should be free to express themselves without being “coordinated” by someone else’s aesthetic sensibilities. If a town’s economy supports good businesses, those businesses will be smart enough to advertise with the right kinds of signs. People love the vibrant look of nearly cacophonous signs in historic photographs of downtowns and then want to reject freedom of expression in preserved downtowns. It doesn’t make sense.

Are “street trees” an oxymoron? How can they be done right?

Crankshaw: Street trees certainly are not an oxymoron in most residential neighborhoods, whose streets were designed with the idea that there would be trees. In many communities we are neglecting the need to maintain and replant trees in neighborhoods to make our streets more enjoyable.

In downtowns, street trees are a different matter. Trees have demonstrable value in traditional commercial areas. They screen parking areas, provide shade, shape space for pedestrians, and have other psychological and aesthetic values. They can provide those benefits without necessarily being lined up in the narrow space between building fronts and the curb. Tree planting in a commercial district requires thought about design goals and planting opportunities to maximize the return on the considerable investment.

This comes from Build a Better Burb (http://buildabetterburb.org), an online publication dedicated to improving suburban design and planning.

I had the honor of hearing Helen Thomas speak at an Ohio Newspaper Association conference several years ago, and even was lucky enough to have my photo taken with her. She will be remembered as a role model and trailblazer for women as much as for “her fierce belief that our democracy works best when we ask tough questions and hold our leaders to account.” Easier said than done! But she helped set the bar for those of us who follow.

Presidents don’t often comment on the deaths of reporters, but Helen Thomas wasn’t your typical reporter. The first woman journalist to cover the president full-time, Thomas reported — aggressively — on ten

Thomas Krick Melinda,I know you share her belief. I am proud of your dedication to journalistic professional standards. Journalism is the 4th part of the equation of checks and balances for a responsible government.

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